Budget for Mediation

This is a simplified expenses form to begin to catch and question your expenses. You likely have expenses not listed here. Please be as comprehensive as you can to insure the best possible outcome in mediation as it requires you to be as forthcoming as you can to insure a long-lasting and thorough agreement coming out of mediation.

Name:                                                              Date:              

I.   Home

A.   Mortgage payments

    1.   Principal                                                                                

    2.   Interest                                                                            
    3.   Taxes                                                                             

    4.   Special assessments                                                        

B.   Apartment rental                                                                               

C.   Home repairs/major cleaning                                                      

D.   Furniture/Appliance maintenance                                                        

E.   Heating fuel                                                                                

F.   Utilities  

    1.   Electricity                                                                                

    2.   Water/garbage/sewer                                                                    

    3.   Telephone                                                                                

    4.   Grounds maintenance                                                                     

G.   Homeowners/Renters insurance                                                           

H.   Domestic help (housekeeper, etc.)                                                      

II.  Personal Maintenance

A.   Food (including eating out)                                 

B.   Clothing                                                                         

C.   Laundry/dry cleaning                                                                         

D.   Medical

    1.  Medical insurance                                                                         

    2.  Additional medical costs                                                

    3.  Dental costs                                                                          

    4.  Eye care/glasses                                                                         

    5.  Mental health                                                                         

    6.  Prescriptions  
E.  Hair care                                                                         

F.   Recreation   

1.  Vacation savings                                                                       

    2.  Summer camp/equipment                                      

    3.  Membership dues                                                                          

    4.  Allowances, children                                                                         

    5.  Entertainment                                                                         

G.   Education/self-improvement     

    1.  Magazines and newspapers                                 

    2.  Records and books                                                                           

    3.  Tuition, classes, etc.                                                                       

H.   Insurance/retirement  

    1.  Life insurance premiums                     

    2.  Accident/disability                                                                         

    3.  Retirement account                                                                         

I.   Child care                                                                         

J.   Contributions                                                                            

K.   Gifts (birthdays, Christmas)  
L.   Transportation

    1.  Auto maintenance gas                                   

    2.  Bus passes                                                                         

    3.  Carpool payments, etc.                                   

    4.  Loan repayment                                                                         

    5.  Auto insurance       
    6.  Repairs allowance                                                                       

    7.  Registration, license, DEQ expense, etc.            

M.   Savings allowance                                                                        

N.   Bank charges                                                                        

O.   Additional debt payments 

P.   Miscellaneous expenses

1.  Tailor, cobbler sundries                                                                    

    2.  Pets - food, medical, grooming, etc.